<ul class="breadcrumb">当前位置：
    <a href="#">首页</a> <span class="divider">/</span>
    <a href="#">业务处理</a> <span class="divider">/</span>
    发货单填写
</ul>
<div class="title_right"><strong>发货单填写</strong></div>
<div style="width:900px;margin:auto;">
    <table class="table table-bordered">
        <tr>
            <td width="10%" align="right" nowrap="nowrap" bgcolor="#f1f1f1">日期：</td>
            <td width="23%"><input type="text"  class="laydate-icon span1-1" id="Calendar" value="2015-08-25"  /></td>
            <td width="10%" align="right" nowrap="nowrap" bgcolor="#f1f1f1">直达站：</td>
            <td width="23%"><input type="text" name="" id="" class="span1-1"  /></td>
            <td width="10%" align="right" nowrap="nowrap" bgcolor="#f1f1f1">中转至：</td>
            <td><input type="text" name="" id="" class="span1-1"  /></td>
        </tr>
        <tr>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">卡号：</td>
            <td><input type="text" name="" id=""  class="span1-1" /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">发货人：</td>
            <td><input type="text" name="" id=""  class="span1-1" /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">电话：</td>
            <td><input type="text" name="" id=""  class="span1-1" /></td>
        </tr>
        <tr>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">票号：</td>
            <td><input type="text" name="input" id="input"  class="span1-1" /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">收货人：</td>
            <td><input type="text" name="input2" id="input2"  class="span1-1" /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">电话：</td>
            <td><input type="text" name="input3" id="input3" class="span1-1"  /></td>
        </tr>
    </table>
    <table class="table table-bordered">
        <tr>
            <td align="center" bgcolor="#f1f1f1"><strong>货物名称</strong></td>
            <td align="center" bgcolor="#f1f1f1"><strong>包装</strong></td>
            <td align="center" bgcolor="#f1f1f1"><strong>数量</strong></td>
            <td align="center" bgcolor="#f1f1f1"><strong>运费</strong></td>
            <td align="center" bgcolor="#f1f1f1"><strong>重量</strong></td>
            <td align="center" bgcolor="#f1f1f1"><strong>体积</strong></td>
            <td align="center" bgcolor="#f1f1f1"><strong>结算方式</strong></td>

        </tr>
        <tr>
            <td align="center"><input type="text" name="input4" id="input4" class=" span2" /></td>
            <td align="center">

                <select name="select" id="select" class=" span1">
                    <option>无</option>
                </select>
            </td>
            <td align="center"><input type="text" name="input5" id="input5" class=" span1 text-center" value="22" /></td>
            <td align="center"><input type="text" name="input6" id="input6" class=" span1 text-center" value="22" /></td>
            <td align="center"><input type="text" name="input7" id="input7" class=" span1 text-center" value="22" /></td>
            <td align="center"><input type="text" name="input8" id="input8" class=" span1 text-center" value="22" /></td>
            <td align="center">
                <select name="select" id="select"  class=" span1">
                    <option>无</option>
                </select></td>

        </tr>
    </table>
    <table class="table table-bordered" >
        <tr>
            <td width="10%" align="right" nowrap="nowrap" bgcolor="#f1f1f1">代收货款：</td>
            <td width="23%"><input type="text" name="input10" id="input10" class="span1-1"  /></td>
            <td width="10%" align="right" nowrap="nowrap" bgcolor="#f1f1f1">中转费：</td>
            <td width="23%"><input type="text" name="input14" id="input14"  class="span1-1" /></td>
            <td width="10%" align="right" nowrap="nowrap" bgcolor="#f1f1f1">保险金额：</td>
            <td><input type="text" name="input15" id="input15" class="span1-1"  /></td>
        </tr>
        <tr>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">保费：</td>
            <td><input type="text" name="input11" id="input1-1" class="span1-1"  /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">送货费：</td>
            <td><input type="text" name="input12" id="input12"  class="span1-1" /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">送货方式：</td>
            <td><input type="text" name="input16" id="input16"  class="span1-1" /></td>
        </tr>
        <tr>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">需要回单：</td>
            <td><input type="checkbox"> 打印标签</td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">返款：</td>
            <td><input type="text" name="input13" id="input13" class="span1-1"  /></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">起站：</td>
            <td>

                <input type="radio"> 自提

                <input type="radio"> 送货


            </td>
        </tr>
        <tr>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">分理站：</td>
            <td nowrap="nowrap"><select name="select2" id="select2" class=" span1-1">
                    <option>郑州</option>
                </select>
                <input type="text" name="input13" id="input13" class="span1" />
                <select name="select2" id="select2" class=" span1">
                    <option>无</option>
                </select></td>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">标签数量：</td>
            <td colspan="3"><input type="text" name="input17" id="input17" class="span1" />

                <input type="checkbox"> 打印标签
            </td>
        </tr>
        <tr>
            <td align="right" nowrap="nowrap" bgcolor="#f1f1f1">备注：</td>
            <td colspan="5" nowrap="nowrap"><input type="text" name="input9" id="input9" class="span10"  /></td>
        </tr>
    </table>

    <table  class="margin-bottom-20  table no-border" >
        <tr>
            <td class="text-center"><input type="button" value="确定" class="btn btn-info  " style="width:80px;" /></td>
        </tr>
    </table>
    <div class="alert">
        <button type="button" class="close" data-dismiss="alert">&times;</button>
        温馨提示：按“Enter”键进行切换；&nbsp;&nbsp;按“F10”保存；&nbsp;&nbsp;按“F5”代收货款；&nbsp;&nbsp;按“F6”返款；
    </div>

</div>